Providers must submit a completed LOI Questionnaire along with a W9 Form to the Texas Children’s Health Plan Network Management Department for consideration.Both documents can be submitted either by fax or email as indicated on the LOI Questionnaire Form. Incomplete LOI Questionnaires and/or missing W9 forms will not be considered.

The Texas Children’s Health Plan Network Management Department will review to ensure the following criteria are met:

Provider is a Texas Medicaid Provider, as applicable

Provides services in one of the Texas Children’s Health Plan service areas

Has admitting privileges at a Texas Children’s Health Plan participating hospital, as applicable

Services provided is a network need for Texas Children’s Health Plan

After review and consideration, Texas Children’s Health Plan’s Network Management Department will notify provider of acceptance or denial of LOI. If accepted, Provider will begin the credentialing and contracting process.

The Credentialing & Contracting Process

Within five (5) business days, prospective providers will receive an email from Texas Children’s Health Plan, generated through AppCentral, requesting for the completion of the appropriate credentialing application. Prospective providerswill also receive 2 copies of the applicable provider services agreement for review and signature.

Once all completed documents are returned (application and signed contracts), Texas Children’s Health Plan will complete the credentialing process within ninety (90) days.

Upon successful completion of the credentialing process, Texas Children’s Health Plan’sP Network Management Department will notify the provider of the following:

Letter of network participation acceptance with the provider’s effective date